10.5 Genitourinary Disorders Flashcards
Anemia in Renal Failure
- Uremic State shortens the life of RBCs
- Kidneys produce erythropoietin and renal failure causes decrease in RBC production.
- Blood loss due to impaired platelet function or frequent blood samples
UTI
Risk Factors
- Reflux of urine
- Bubble baths
- Girls are at higher risk due to shorter urethra so bacteria does not have to travel as far.
- Catheters
- Sexual activity
- Tight clothing
- We would like to halt the ascension of UTIs (because UTIs travel up) so early intervention is important.
Clinical Manifestations
Infants
- Fever and generalized irritability
- Poor feeding
- Foul smelling urine
- Dehydration
Younger Children
- Pain when voiding
- Enuresis (incontinence during the day)
- Foul urine
- Flank pain
Older Children
- Pain when voiding
- Frequent urination
- May hold urine because of how painful it is
Treatment
- Antibiotics (broad spectrum first then targeted)
- Identify the bacteria
- Antipyretics to fix fevers
Education
- How to prevent UTI
- Wipe from front to back
UTI Pyelonephritis
- UTI has reached the kidneys
- Most of the time it is caused by E-Coli
- Infections originate either in the bladder or blood stream
Symptoms
- Fever
- Vomiting
- Flank pain
- General malaise (chills, nausea, pain with urination)
Diagnosis
- DMSA (radioactive material administered through IV and infected areas of the kidneys light up on the scan.
UTI Cystitis
- UTI that has stayed in the bladder
- Can occur with pyelonephritis or has not progressed to pyelonephritis yet.
- Un-circumcised males are at risk in the first few months because pathogens can get trapped under the foreskin.
UTI Diagnosis
Urine analysis and Urine Culture
Urine Culture
- With younger children we need to obtain it through a catheterization (because it needs to be sterile for urine culture)
- With older children they can pee into a cup
Urinalysis
- Hematuria
- Nitrates in urine (means there is bacteria)
- Leukocyte esterase (indicator of pyuria - pus in urine)
Imaging
UTIs that develop between 2-24 months
- Bladder and Kidney Ultrasound will be ordered to make sure there is no structural abnormalities or reflux
If the Ultrasound is positive for hydronephrosis, scarring, high grade VUR or obstructive uropathy they will schedule VCUG (x-ray with contrast while patient is voiding to make sure urine is moving the way it should to identify structural abnormalities or obstructions/reflux)
Vesicoureteral Reflux (VUR)
- Backward flow of urine from the bladder up into kidneys (retrograde flow)
Primary Reflux
- Caused by congenital abnormalities
Secondary Reflux
- Caused by some type of acquired condition
- Reflux can cause renal scarring and UTI
- One of the main causes of pyelonephritis
Treatment
- Surgery of congenital abnormality (for primary)
Hypospadias
- Congenital anomaly in young mails where urethral opening is below the glans penis (on ventral surface)
Treatment
- Surgery between 6-12 months
- Needs to be corrected for fertility, normal voiding, and esthetics.
Hypospadias (below)
Epispadias (on the dorsal (top) of penis)
Chordee
- Bend in the penis due to fibrous chord attached
- Degree of bend dictates treatment (often seen with hypospadias)
Treatment
- Clip the cord
Obstructive Uropathy
- Structural or functional abnormalities of urinary system that obstructs flow of urine.
Common Causes
- Abnormal valves of urinary tract
- Polycystic nodules in the kidneys
- Stricture (closing) of ureter or urethra
- Fibrous bands
- Can cause reflux
Treatment
- Surgery to get rid of the obstruction (may require external system for urine to flow)
- Prophylactic medication to prevent UTIs
Education
- Teach parents how to catheterize child through the external system
S/S
- Increase in urinary stasis and pressure in the urinary system which can lead to hydronephrosis (dilation of renal pelvis due to backed up fluid)
Phimosis
- Narrowing or stenosis of opening of foreskin which prevents foreskin from retracting appropriately
- Only a problem if it obstructs urinary flow
Education
- Teach parents to return foreskin to normal position if they retract it, and to clean around retraction site
Paraphimosis
- Partial retraction of foreskin with swollen glans that cannot return to normal position due to swelling
- This is an issue because it can cause necrosis of the glans penis if not corrected
- EMERGENCY
Hydrocele
- Peritoneal fluid that descends into the testicles
Communicating Hydrocele
- Processes Vaginalis still open so peritoneal fluid is forced in by intraabdominal pressure and/or gravity.
Non-Communicating Hydrocele
- Resolves on its own as fluid is reabsorbed.
S/S
- Bulge in inguinal area or scrotum.
- Hydrocele typically increases in size as the day goes on (smallest in the morning and bigger at night)
- ASYMPTOMATIC (does not cause pain or discomfort)
Treatment
- Surgery if it has not corrected itself by age 1
Diagnosis
- Transillumination (light on scrotum. If you can see the light through the scrotum then it is fluid in the scrotum)
Cryptorchidism
- Failure of 1 or both testes to descend into the scrotum
Abdominal
Canalicular - Between internal/external inguinal rings
Ectopic - Outside the normal pathways of descent
Risk Factors
- Preterm
Retractile Testes
- Typically resolves on its own by 1 years of age
- If this issue does not resolve on its own we use a ORCHIOPLEXY which is surgery to move testes where it needs to be
Testicular Torsion
- Twisting of spermatic cord
- EMERGENCY DUE TO LACK OF BLOOD FLOW GETTING TO TESTES
S/S
- Sudden pain/nausea/vomiting
- Swollen testicle
- Erythema/Warmth
- Occluded blood supply
